I don't want to wear the metal braces, what are my options?

There is now a wide choice of more discrete brace options for patients of all ages, including:

Ceramic brackets - made in a white or tooth coloured material Lingual braces - placed out of sight on the back of the teeth
Aligners - removable clear plastic appliances which fit over the teeth and progressively move them to the desired position

Each option has its advantages and disadvantages and specialist advice is essential.

Ceramic brackets

Ceramic brackets are tooth coloured or translucent. They are less conspicuous than metal brackets and therefore often favoured by adults. However they do have a number of drawbacks which need to be taken into account. The brace tends to become discoloured over the course of time by contact with foods and may become less pleasing in appearance. The brackets are more prone to breakage than metal brackets; the wires slide through the slots less freely so treatment may take longer; the brackets tend to be abrasive and may cause wear to teeth in the opposite jaw if they should make contact when biting; the brackets can sometimes be difficult to remove with a slightly higher risk of damage to the tooth surface. The brackets are also more costly than metal brackets, and with all the associated problems the overall treatment can be expected cost significantly more. Having said all this, if appearance is at a premium, ceramic brackets may still be the first choice for many patients.

Lingual appliances

These are attached to the lingual surface of the teeth, i.e. the surface towards the tongue. In this position they are virtually invisible. The technique involves special skills and needs considerable experience on the part of the orthodontist to achieve good results. Only a limited number of orthodontists offer this technique and you may need to search for a suitable practitioner who has the requisite experience. The main drawbacks are that it can cause soreness of the tongue and affect speech. Fees are always much higher than for conventional fixed braces because of the higher material costs, greater surgery time involved and the extra training needed.

Aligners

These relatively new appliances blend modern technology with the long-standing concept of using clear flexible splints to ease teeth into line. A succession of splints is worn, each splint bringing the teeth a little closer to the desired position. The splints are effectively invisible and are therefore an attractive option from the standpoint of appearance.

Aligners can be very effective if all that is required is to align mildly irregular teeth. However there are several drawbacks. In the more severe cases, notably those where extractions are required, aligners lack the necessary control of the teeth to give consistently good results and often lead to disappointment. Likewise they are not well suited to correcting problems like prominent upper incisor teeth.

The cost is much higher than for conventional fixed braces owing to the high laboratory costs in making the aligners. In selected cases they they are very effective but their scope is limited.